Impacts of False Alarms in Critically Ill Patients with Heart and Lung Failure

描述(由申请者提供)：这个以患者为导向的指导研究职业发展奖的目的是为宾夕法尼亚大学和费城儿童医院儿科助理教授Christopher P.Bonaded医学博士和MSCe博士的长期目标做好准备，他的长期目标是成为一名独立的临床研究科学家，专注于评估预防住院期间心脏骤停和其他不良事件的干预措施，并将有效的干预措施转化为临床实践。他的直接目标是获得必要的培训、指导和研究经验，以成功竞争支持该领域干预研究的R01拨款。为了实现这一目标，博纳塞德博士和他的导师们制定了一项全面的职业发展计划，包括四个组成部分，包括(A)临床信息学、事件发生时间分析和临床试验方面的高级培训 (B)博纳赛德博士拥有合作和奖学金记录的团队的密集辅导，团队成员包括Ron Keren医学博士、公共卫生硕士(主要导师)、Vinay Nadkarni医学博士(联合导师)、John Holmes博士(联合导师)和Russell Localio博士(高级生物统计顾问)；(C)与临床有效性研究、信息学和医疗器械工程方面的专家参加合作研究研讨会，以及(D)创新研究计划，以调查生理监测技术相关的潜在危害，生理监测技术是识别恶化的早期迹象和预防心脏骤停的关键工具。尽管有巨大的潜力，但生理监测器每天可以为每个患者产生数百个警报，其中高达86%是错误的。候选人假设，错误的警报会导致警报疲劳，推迟对可能代表心脏或呼吸骤停即将到来的真实迹象的警报的反应，并不必要地中断导致错误和患者伤害的高风险任务。博纳塞德博士的目标是在心脏骤停和其他不良事件的高风险患者群体中严格评估这些错误警报的潜在影响，这些患者是患有或预计存在心肺衰竭的危重儿童。他将使用视频和直接观察方法来(1)通过测量虚警率和护士对危重警报的反应时间之间的关联来评估警报疲劳对患者的影响，以及(2)在这一高危患者群体中确定由于生理监测警报而造成的中断与用药错误之间的关联。这些发现将为未来的R01提案提供支持和参考，这些提案的重点是评估改善生理监护仪的信噪比的策略，并将这些策略转化为临床实践，以防止院内心脏骤停和其他不良事件。上面概述的研究和职业发展活动将在宾夕法尼亚大学和费城儿童医院的合作学术环境中进行，并得到国际公认的导师和顾问团队的支持，以确保博纳迪德博士的成功。

DESCRIPTION (provided by applicant): The purpose of this Mentored Patient-Oriented Research Career Development Award is to prepare Christopher P. Bonafide, MD, MSCE, Assistant Professor of Pediatrics at the University of Pennsylvania and The Children's Hospital of Philadelphia for his long-term goal of becoming an independent clinical research scientist focused on evaluating interventions to prevent in-hospital cardiac arrest and other adverse events, and translating effective interventions into clinical practice. His immediate goal is to obtain the training, mentorship, and research experience necessary to successfully compete for R01 grants supporting intervention studies in this area. To meet this goal, Dr. Bonafide and his mentors have developed a comprehensive career development plan with four components, including (a) advanced training in clinical informatics, time-to-event analysis, and clinical trial design, (b) intensive mentorship from a team with whom Dr. Bonafide has a track record of collaboration and scholarship including Ron Keren, MD, MPH (primary mentor), Vinay Nadkarni, MD, MS (co-mentor), John Holmes, PhD (co-mentor), and Russell Localio, PhD (senior biostatistics advisor), (c) participation in collaborative research seminars with experts in clinicl effectiveness research, informatics, and medical device engineering, and (d) an innovative research plan to investigate the potential harms associated with physiologic monitoring technology, a critical tool in recognizing early signs of deterioration and preventing cardiac arrest. Despite their great potential, physiologic monitors can generate hundreds of alarms per patient each day, up to 86% of which are false. The candidate hypothesizes that false alarms lead to alarm fatigue, delaying responses to alarms that may represent true signs of impending cardiac or respiratory arrest, and unnecessarily interrupt high-risk tasks leading to errors and patient harm. Dr. Bonafide aims to rigorously evaluate these potential impacts of false alarms in a population of patients at high risk of cardiac arrest and other adverse events: critically ill children with existing or projected heart and/or lung failure. He will use video and direct observational methods to (1) evaluate the patient-oriented impact of alarm fatigue by measuring the association between the rate of false alarms and nurse response time to critical alarms, and (2) determine the association between interruptions due to physiologic monitor alarms and medication administration errors in this high-risk patient population. The findings will provide evidence to support and inform future R01 proposals focused on evaluating strategies to improve the signal-to-noise ratio of physiologic monitors and translating these strategies into clinical practice to prevent in-hospital cardiac arrest and other adverse events. The research and career development activities outlined above will take place in the collaborative academic environment of the University of Pennsylvania and The Children's Hospital of Philadelphia with the support of an internationally-recognized team of mentors and advisors, assuring Dr. Bonafide's success.